Diseases Of Nasal Septum

Question 1

Septal perforation

Answer 1

Perforation on the nasal septum

Question 2

Most common cause of nasal septal perforation

Answer 2

Trauma

Question 3

Forms of traumatic septal perforation

Answer 3

1) Injury to mucosal flaps during SMR
2) cauterisation of septum with chemicals
3) galvanocautery for epistaxis
4) habitual nose picking
5) perforated voluntarily for putting ornaments

Question 4

Forms of pathological septal perforations

Answer 4

1) septal abscess
2) nasal myiasis
3) rhinolith
4) chronic granulomatous conditions like TB, lupus, leprosy&raquo_space;> affects cartilage
Syphilis affects&raquo_space;> bony cartilage
5)wegeners granuloma

Question 5

Aetiology of nasal septal perforation

Answer 5

1) traumatic
2) pathological
3) drugs and chemicals
4) idiopathic

Question 6

Forms of Pharmacological septal perforation

Answer 6

1) prolonged use of steroids
2) cocaine addicts
3) workers eg 1- chromium plating
2- dichromate
3-soda ash
4- arsenic and it’s compounds

Question 7

Form of idiopathic septal perforation

Answer 7

Unknown cause.

Patient is unaware of its existence

Question 8

Small anterior perforation causes what

Answer 8

Causes whistling sound during inspiration or expiration

Question 9

Large perforation develop what

Answer 9

Develop crust which obstruct the nose or cause severe epistaxis when removed

Question 10

Treatment of small septal perforation

Answer 10

Septal button

Question 11

How to detect cause of perforation

Answer 11

Biopsy from the granulations or from the edges of the perforation

Question 12

Symptoms associated with perforation

Answer 12

Crusting, epistaxis, whistling— main

Other symptoms- feeling of dryness, emptiness in the nose, feeling of discomfort

Question 13

Symptoms of nasal perforation depends on

Answer 13

Size and position of perforation

Question 14

Pick ulcer

Answer 14

Aggressive nasal self toilet with digital trauma or tissues will convert an inflamed mucous membrane into ischemia crusty area.
Patients often deny this.
Pick ulcer» cartilage exposure&raquo_space;cartilage necrosis&raquo_space; cartilage perforation

Question 15

Which is the best method to assess the margins and state of the nasal septum

Answer 15

Endoscopy

Question 16

Investigations needed in septal perforation

Answer 16

Full blood count, ESR, urine and electrolytes, C -ANCA, treponemal investigation, ACE titres, chest X ray, nasal swab

Question 17

Why is biopsy not diagnostic in septal perforation

Answer 17

1) it reveals nothing other than chronic inflammation

2) May convert an inactive state to an active state»> enlargement of the perforation

Question 18

Biopsy are indicated only in

Answer 18

Idiopathic cause

Septum with irregular margin

Question 19

Neoplasticism septal perforation

Answer 19

1) melanoma
2) adenocarcinoma
3) squamous cell carcinoma
4) metastatic carcinoma
5) lymphoma

Question 20

Nasal steroid sprays causes septal perforation. How to reduce the incidence of septal perforation?

Answer 20

Patients should use the spray with the opposite hand to the nostril being treated

Question 21

An nasal septal ulcer appeared after steroidal therapy.what would u do?

Answer 21

Withdraw the medication

Question 22

Management of septal perforation

Answer 22

1) prevention
2) obturation
3) surgical

Question 23

Prevention of septal perforation after septal surgeries

Answer 23

Use of mucosal protectant
antiseptic silicon barrier creams
Avoidance of aggressive cleaning

Question 24

Non surgical management of septal perforation

Answer 24

Alkaline nasal douches, saline sprays, petroleum based ointment

Question 25

Obturation

Answer 25

Inert sialistc sheeting - to prevent drying and encourage epithelializatoon over the cartilage or bony septum to create a mature mucosal edge

Question 26

Disadvantage of using an obturator

Answer 26

1) mucosal irritation

2) granuloma formation

Question 27

Repairs used in septal perforation

Answer 27

1, free grafts
  1) simple or composit auto grafts
   2) allografts
2, pedicled flaps
   1) local nasal mucosal
   2) Buccal  mucosal
   3)composite septal cartilage and mucosa
   4)composite skin or cartilage

Question 28

Surgery for septal perforation

Answer 28

Bilateral mucosal flap repair with staggered mucosal rotation or transposition flap closure and connective tissue interposition graft